Incidence and clinical significance of lesions presenting as a scalp mass in adult patients

Background Lesions initially presenting as a scalp mass are quite common entities with a wide spectrum of causes. They may be directly related to the scalp itself or may be secondary stigmata of an underlying process in the skull. The rate and clinical significance of the differential diagnosis of these lesions are not well studied in the adult population. Methods Three hundred sixty patients were operated on for scalp masses at our hospital between January 2011 and February 2014. The patients were defined retrospectively by using the hospital coding system for scalp lesions. Among these patients, 15 were excluded for being younger than 16 years old. Results A total of 345 patients, consisting of 172 females (49.9 %) and 173 males (50.1 %), were included in the study. The mean age at diagnosis was 44.3 (16–89). There were no mortalities during the follow-up period (mean 17.99 months). Mean numbers of scalp lesions and surgeries were 1.25 and 1.18, respectively. There were 32 distinct histopathological diagnoses, the 5 most common being trichilemmal cyst, epidermal cyst, lipoma, nevus and sebaceous cyst in order of frequency. The rate of “clinically significant” pathologies, meaning malignancies or those needing follow-up, was around 7.8 %. The incidence of correct preoperative diagnosis with respect to the departments was 13–27 %. Conclusions Our series indicated that generally scalp masses were underestimated and detailed preoperative diagnostic workup or interdisciplinary consultations were not performed regularly. The overall incidence of clinically significant lesions warrants a high degree of vigilance for accurate diagnosis and management of these lesions, because their etiology can be so variable and challenging.